Transrectal Ultrasound-Assisted Optic Internal Urethrotomy for Management of Complete Obliteration of Posterior Urethra and Bladder Neck*

Abstract

The management of posterior urethral obliteration secondary to urethral disruption associated with pelvic fracture has been one of the greatest challenges to a urologist. Although different surgical procedures are available, a recent prevailing notion has been that if feasible, any completely obliterated urethra may be tried out with an optic urethrotomy to regain the alignment.A decisive incision by the cold knife over the site of urethral obliteration into the urinary bladder could be guided precisely by linear transrectal ultrasound used concomitantly with an optic urethrotomy. In a period of 2 years, transrectal ultrasound-guided optic urethrotomy was conducted successfully in five patients with traumatic complete posterior urethral obliteration and two with complete bladder neck obstruction. Although as many as six subsequent optic urethrotomies have been required for extremely long segment obliterations, there has been no impotence or, urinary incontinence over a period of 12 to 30 months. Optic urethrotomy proved to be a reasonable option for the management of posterior urethral obliteration. The application of transrectal ultrasound during the endoscopie procedure is a convenient adjunct, promoting an uneventful and successful optic internal urethrotomy for the treatment of urethral obliteration.